Revai Krystal, McCormick David P, Patel Janak, Grady James J, Saeed Kokab, Chonmaitree Tasnee
Department of Pediatrics, University of Texas Medical Branch, Galveston, TX 77555-0371, USA.
Pediatrics. 2006 May;117(5):1823-9. doi: 10.1542/peds.2005-1983.
The heptavalent pneumococcal conjugate vaccine (PCV7) has been shown to reduce the incidence of acute otitis media (AOM) caused by Streptococcus pneumoniae by 34% and reduces the overall incidence of AOM by 6% to 8%. More recent studies have shown increases in the proportion of Haemophilus influenzae and Moraxella catarrhalis in the middle-ear fluid of PCV7-immunized children. There has been no report on the effect of PCV7 on all 3 bacterial pathogens combined, either in the middle-ear fluid or nasopharynx of individual children with AOM. We investigated the impact of PCV7 on nasopharyngeal colonization with bacterial pathogens during AOM in the pre-PCV7 and post-PCV7 vaccination eras. Four hundred seventeen children (6 months to 4 years of age) were enrolled onto AOM studies between September 1995 and December 2004. Of these, 200 were enrolled before the vaccine use (historical controls), and 217 were enrolled after the initiation of PCV7 vaccination (101 were underimmunized, and 116 were immunized). Although the nasopharyngeal colonization rate for S pneumoniae was not different between the 3 groups, a significantly higher proportion of PCV7-immunized children with AOM were colonized with M catarrhalis. Overall, the mean number of pathogenic bacteria types isolated from immunized children (1.7) was significantly higher than in controls (1.4). The increase in bacterial colonization of the nasopharynx during AOM could be associated with an increase in AOM pathogens and theoretically can predispose PCV7-immunized children with AOM to a higher rate of antibiotic treatment failure or recurrent AOM.
七价肺炎球菌结合疫苗（PCV7）已被证明可使肺炎链球菌引起的急性中耳炎（AOM）发病率降低34%，并使AOM的总体发病率降低6%至8%。最近的研究表明，在接种PCV7的儿童中耳液中，流感嗜血杆菌和卡他莫拉菌的比例有所增加。关于PCV7对AOM患儿中耳液或鼻咽部中所有三种细菌病原体联合作用的影响尚无报道。我们调查了PCV7在PCV7疫苗接种前和接种后时代对AOM期间细菌病原体鼻咽部定植的影响。1995年9月至2004年12月期间，417名6个月至4岁的儿童被纳入AOM研究。其中，200名在疫苗使用前入组（历史对照），217名在PCV7疫苗接种开始后入组（101名免疫不足，116名免疫）。虽然三组之间肺炎链球菌的鼻咽部定植率没有差异，但AOM的PCV7免疫儿童中卡他莫拉菌定植的比例显著更高。总体而言，从免疫儿童中分离出的病原菌类型平均数量（1.7种）显著高于对照组（1.4种）。AOM期间鼻咽部细菌定植的增加可能与AOM病原体的增加有关，理论上可能使AOM的PCV7免疫儿童抗生素治疗失败率或复发性AOM的发生率更高。
